Provider Demographics
NPI:1003575499
Name:LOS ROBLES PHARMACY INC
Entity Type:Organization
Organization Name:LOS ROBLES PHARMACY INC
Other - Org Name:LOS ROBLES PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:CALEB
Authorized Official - Middle Name:
Authorized Official - Last Name:WEILER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-601-6820
Mailing Address - Street 1:68 LONG CT STE 1C
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-7413
Mailing Address - Country:US
Mailing Address - Phone:805-601-6820
Mailing Address - Fax:805-601-6830
Practice Address - Street 1:68 LONG CT STE 1C
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-7413
Practice Address - Country:US
Practice Address - Phone:805-601-6820
Practice Address - Fax:805-601-6830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-13
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHY58161OtherBOARD OF PHARMACY